OBJECTIVES: The risk of post-discharge venous thromboembolism (VTE) and bleeding in total knee and hip arthroplasty (TKA/THA) has not been completely elucidated because interventions to reduce these adverse outcomes have evolved rapidly. The objective of this study was to determine the incidence of these events and associated risk factors, and to evaluate the use of thromboprophylaxis. METHODS: Administrative medical records (2004–2009) from a large healthcare plan were linked to an inpatient database of 450 hospitals in the United States. Adult patients undergoing TKA or THA with no evidence of prior orthopaedic surgeries, prior VTE, post-discharge revision surgeries, or death were included. ICD-9-CM diagnosis and CPT/HCPC procedure codes were used for evaluating symptomatic VTE and bleeding rates 90 days post-surgery. Multivariate analyses were performed to identify predictors of VTE and bleeding after hospitalization.  RESULTS: Two hundred twenty-six of 9167 patients (2.5%; 3109 THA, 6058 TKA) with a median age of 60 years and a mean Charlson-Quan comorbidity index score of 0.5 experienced VTE, and 324 (3.5%) had bleeding. Most of these events occurred post-discharge (70% and 79%, respectively). Over 50% of VTE occurred within 30 days post-discharge. Consistent predictors of VTE and bleeding after hospitalization were inpatient VTE or bleeding, respectively, and all-cause rehospitalization. Post-discharge thromboprophylaxis was not a significant risk factor for bleeding. Ninety-eight percent of patients received thromboprophylaxis during hospitalization; 26% received it post-discharge. During hospitalization, three-fourths of patients received enoxaparin and/or warfarin, often in combination with mechanical prophylaxis devices (57%). Post-discharge, mean antithrombotic drug exposure was 7.4 days.  CONCLUSIONS: Patients who experience VTE or bleeding during hospitalization and patients who are rehospitalized are at greatest risk of thromboembolic and bleeding outcomes, respectively, post-discharge. These data also suggest that the use of thromboprophylaxis following hospitalization should not significantly increase the risk of post-discharge bleeding after TKA/THA.